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  • Cholera and Management of Dehydration: by Yunus Ramadhan Facilitated by DR Kibengo Freddie

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    This document discusses cholera, an acute diarrheal disease caused by the bacteria Vibrio cholerae. It can cause rapid dehydration and death through profuse watery diarrhea. Cholera remains a major public health threat in Uganda, with over 1,850 reported cases and 45 deaths annually. The bacteria secretes an enterotoxin that promotes fluid secretion into the small intestine, overwhelming the body's ability to absorb fluid if not treated promptly with oral rehydration salts and intravenous fluids for severe cases. Antibiotics such as doxycycline or ciprofloxacin are also used as an adjunct to rehydration therapy.

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    This document discusses cholera, an acute diarrheal disease caused by the bacteria Vibrio cholerae. It can cause rapid dehydration and death through profuse watery diarrhea. Cholera remains a major public health threat in Uganda, with over 1,850 reported cases and 45 deaths annually. The bacteria secretes an enterotoxin that promotes fluid secretion into the small intestine, overwhelming the body's ability to absorb fluid if not treated promptly with oral rehydration salts and intravenous fluids for severe cases. Antibiotics such as doxycycline or ciprofloxacin are also used as an adjunct to rehydration therapy.

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    24 views18 pages

    Cholera and Management of Dehydration: by Yunus Ramadhan Facilitated by DR Kibengo Freddie

    Uploaded by

    Nina
    This document discusses cholera, an acute diarrheal disease caused by the bacteria Vibrio cholerae. It can cause rapid dehydration and death through profuse watery diarrhea. Cholera remains a major public health threat in Uganda, with over 1,850 reported cases and 45 deaths annually. The bacteria secretes an enterotoxin that promotes fluid secretion into the small intestine, overwhelming the body's ability to absorb fluid if not treated promptly with oral rehydration salts and intravenous fluids for severe cases. Antibiotics such as doxycycline or ciprofloxacin are also used as an adjunct to rehydration therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 18

    Cholera and management of

    dehydration
    By Yunus Ramadhan
    Facilitated by
    Dr Kibengo Freddie
    Objectives
    • Introduction
    • Epidemiology
    • Etiology
    • Risk factors
    • Pathophysiology
    • Clinical presentation
    • Assessment for dehydration
    • Treatment and management
    Introduction
    Cholera is an acute diarrheal disease that can in a matter of hours, result in profound,
    rapidly progressive dehydration and death.
    The hallmark of this infection is profuse secretory diarrhea
    Cholera can be endemic, epidemic, pandemic. Despite all the major advances in
    research cholera remain a challenge to modern medical world. Cholera is transmitted
    via fecal-oral route
    It remain a major health threat to developing world
    Epidemiology
    Cholera remains a major health public health threat leading to many cases and death
    annually in Uganda. The country reports an average of 1850 cholera cases and 45
    deaths annually
    The districts of Nebbi, Hoima, Buliisa and Mbale contributed to 60% of all reported
    cholera cases between 2011-2016
    Etiology
    There are over 200 serogroups of vibrio cholerae but the ones that cause clinical
    disease are only two that is
    • V cholerae serogroup 01
    • V cholerae serogroup 0139
    Risk factors
    • Environmental factors
    - Seasonal rise in the number of organisms
    - Poor water hygiene
    - Poor community sanitation
    • Host factors
    - Malnutrition
    - Hypochlorhydria and achlorhydria of any cause eg
    H pylori infection
    Gastric surgery
    Vagotomy
    Use of H2 blockers, PPIs,
    - People with blood group O the incidence is twice
    Pathophysiology
    V cholerae is a comma shaped gram negative aerobic or facultatively anaerobic bacillus
    that varies in size from 1-3 micrometer in length and 0.5-0.8 micrometer in diameter
    The organism cause clinical disease by producing an endotoxin that promote the
    secretion of fluid and electrolytes into the lumen of the small intestine. The enterotoxin
    acts locally and does not invade the intestinal wall. As a result few neutrophils are
    found in the stool
    To reach the small intestines, the organism has to negotiate the normal defense
    mechanism of the GI tract
    Because the organism is not acid resistant it requires a large inoculum to withstand
    gastric acidity
    The infectious dose for V cholerae required to cause clinical disease varies with mode of
    administration
    - If ingested with water the infectious dose is 10^3-10^6 organisms
    - If ingested with food the infectious dose 10^2-10^4 organisms
    The toxin activates adenylate cyclase to cause a net increase in cAMP.
    cAMP blocks the absorption of sodium and chloride by microvilli and promotes the
    secretion of chloride and water by crypt cells. The result is watery diarrhea with
    electrolyte concentration isotonic to those of plasma
    Fluid loss originates in the duodenum and upper jejunum the ilium is less affected
    The colon is usually in a state if absorption because it is relatively insensitive to the
    toxin
    However, the large volume of fluid lost by upper intestines overwhelms the absorptive
    capacity of the lower bowel resulting in severe diarrhea
    Unless the lost fluid and electrolytes are replaced adequately the infected person can
    develop shock from profound dehydration and acidosis from loss of bicarbonate
    Clinical presentation
    • Diarrhea
    The stool has a characteristic appearance: a nonbilious, gray, slightly cloudy fluid with
    flecks of mucus, no blood, and a somewhat fishy inoffensive odor. It has been called
    "rice-water" stool because of its resemblance to the water in which rice has been
    washed

    • Vomiting
    • Dehydration
    Clinical signs
    • 3-5% loss of normal body weight
    Excessive thirst
    • 5-8% loss of normal body weight
    Postural hypotension, tachycardia, weakness, dry mucous membranes
    • >10% loss of normal body weight
    Oliguria
    Glassy or sunken eyes
    Sunken fontanelles in infants
    Weak, thread, or absent pulse
    Somnolence
    Coma
    Classification of dehydration
    • No dehydration
    • Some dehydration
    • Severe dehydration
    • Metabolic and systemic complications
    - Hypoglycemia
    - Hypokalemia
    - Acidemia
    - Bicarbonate loss
    DDX
    • E coli infection
    • Gastroenteritis
    • Rotavirus infection
    Workup
    • Stool analysis
    • Stool culture
    • Hematological tests
    • Metabolic panel
    Treatment and management
    • Rehydration
    • Antibiotic treatment
    Severe dehydration Intravenous drips of Ringers lactate or if not 100ml/kg in 3h period
    available normal saline and oral rehydration Start rapidly (30ml/kg within 30min then
    salts slow down)
    Total amount for first 24h 200ml/kg

    Some dehydration Oral rehydration salts 2200-4000ml

    No dehydration Oral rehydration salts 2000ml/day


    Antimicrobial therapy
    • Doxycycline
    • Tretracycline
    • Furazolidone
    • Trimethoprim- sulfamethoxazole
    • Ciprofloxacin
    • Ampicillin
    • Erythromycin
    Antimicrobial therapy is an adjunct to fluid therapy

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